Substance Use Disorder

Substance use disorder is a treatable mental health condition affecting millions of people. While it can significantly impact your health, relationships, and daily life, recovery is possible with proper support and treatment.

Table of contents

• What is substance use disorder?
• Types of substance use disorders
• Recognizing the signs and symptoms
• What causes substance use disorder?
• How it affects your life
• Getting a diagnosis
• Treatment and recovery options
• Recovery is possible

What is substance use disorder?

Substance use disorder, formerly known as drug addiction, is a mental health condition where you experience a problematic pattern of substance use that affects your health and quality of life.^[1] It is a chronic disease, which means it is a long-lasting condition that requires ongoing management, similar to diabetes or heart disease.^[2]

Substances change how your brain functions over time. They release dopamine, a chemical in your brain that makes you feel good, until the substance wears off. Your brain and body want to continue this good feeling, even if it’s unhealthy.^[3] This explains why people with substance use disorders have trouble controlling their drug use even though they know drugs are harmful. Overcoming a substance use disorder is not as simple as resisting the temptation to take drugs.^[4]

Substance use disorder exists on a spectrum and may be mild, moderate, or severe. In 2022, more than one in six Americans aged 12 or older reported experiencing a substance use disorder.^[5] However, more than 85% of them did not receive substance use treatment during that time.^[6]

Types of substance use disorders

A substance use disorder can involve many different types of substances. Some of the most common types include:^[7]

• Alcohol use disorder
• Cocaine use disorder
• Cannabis use disorder
• Tobacco use disorder
• Methamphetamine use disorder
• Opioid use disorder

Alcohol use disorder is the most common type of substance use disorder in the United States.^[8] It’s also common to have more than one substance use disorder at a time, such as alcohol use disorder and tobacco use disorder. This is known as a polysubstance use disorder.^[9]

Substance use disorders can be applied to the following types of drugs: alcohol, cannabis, hallucinogens, inhalants, opioids (prescription and illegal), sedatives, hypnotics or anxiolytics, stimulants and psychostimulants, tobacco (nicotine), and other unknown substances.^[10]

Recognizing the signs and symptoms

The symptoms and effects of substance use disorder vary based on the type of substance you use. There are two groups of symptoms based on when or if the substance is in your body:^[11]

Intoxication is the immediate and short-term effect of a substance in your body. Symptoms include feeling sleepy, calm, excited, or experiencing intense emotions. The substance can also affect your judgment and decision-making or physical and mental functioning.

Withdrawal symptoms happen when the short-term effects of a substance wear off and the substance starts to leave your body. Symptoms are unpleasant and could include nausea and vomiting, diarrhea, sweating, difficulty sleeping, muscle cramping, and mood changes.^[12]

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the signs of substance use disorder include:^[13]

• Taking the substance in larger amounts and for a longer amount of time than you’re meant to if it’s a prescription
• Having a strong desire or urge to use the substance
• Having unsuccessful efforts to cut down on or manage substance use
• Spending a lot of time obtaining or using the substance or recovering from its effects
• Having issues fulfilling responsibilities at work, school, or home due to substance use
• Continuing to use the substance, even when it causes problems in relationships
• Giving up social, occupational, or recreational activities because of substance use
• Using substances again and again, even when it puts you in danger
• Continuing substance use despite an ongoing physical or psychological problem that’s likely caused or worsened by the substance
• Developing tolerance, which means needing increased amounts to get the same effect
• Experiencing withdrawal symptoms, which can be relieved by taking more of the substance

What causes substance use disorder?

The exact cause of a substance use disorder isn’t well understood. However, research shows that changes to your brain’s reward system play an important role. No single factor can predict whether you’ll develop an addiction. A combination of factors influences your risk, including your individual biology, social environment, age or stage of development, and genes.^[14]

Your genes and environmental influences account for about half of your addiction risk. Sex, ethnicity, and mental disorders also contribute to your risk. Your environment includes family, friends, and socioeconomic status. The more risk factors you have, the greater your chance of addiction.^[15]

Addiction is a chronic, often relapsing brain disease. It causes compulsive substance seeking and use despite harmful consequences to you and to those around you. The initial decision to misuse substances may be voluntary, but the brain changes over time. It challenges self-control and your ability to resist intense impulses to use substances.^[16]

How it affects your life

Substance use disorder can significantly impact your emotional well-being, relationships, education, and career. In many cases, it’s life-threatening.^[17] Substance use disorders can lead to significant problems in all aspects of a person’s life. Patterns of symptoms resulting from substance use can help a doctor diagnose a person with a substance use disorder and connect them to appropriate treatment.^[18]

Getting a diagnosis

Diagnosing substance use disorder requires a thorough evaluation and often includes an assessment by a psychiatrist, a psychologist, or a licensed alcohol and drug counselor. Blood, urine, or other lab tests are used to assess drug use, but they’re not a diagnostic test for addiction. However, these tests may be used for monitoring treatment and recovery.^[19]

For diagnosis of a substance use disorder, most mental health professionals use criteria in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.^[20] Seeking medical care as soon as you have signs of substance use disorder is essential.

Treatment and recovery options

Although there’s no cure for substance use disorder, treatment options can help you overcome an addiction and stay drug-free. Like many other chronic conditions, treatment is available for substance use disorders. Your treatment depends on the drug used and any related medical or mental health disorders you may have. Long-term follow-up is important to prevent relapse.^[21]

While no single treatment method is right for everyone, recovery is possible, and help is available for patients with substance use disorders. Evidence-based guidelines can assist doctors with choosing the right treatment options. These guidelines help evaluate a patient’s clinical needs and situation to match them with the right level of care, in the most appropriate available setting.^[22]

Treatment approaches

Several different treatment approaches exist for substance use disorders, and they each work in different ways. Some treatments help change thoughts and behaviors, while others focus on managing cravings and withdrawal symptoms. Effective substance use disorder treatments address the whole person, often combining multiple approaches tailored to the individual’s needs.^[23]

Types of treatment include:^[24]

• Medications to ease withdrawal symptoms, reduce cravings, and prevent using substances again
• Behavioral therapy to develop coping skills, address personal challenges, and build skills for managing triggers
• Holistic support to meet a person’s medical, social, work-related, and legal needs

Treatment programs and settings

Treatment programs for substance use disorder usually offer individual, group, or family therapy sessions. They focus on understanding the nature of addiction, becoming drug-free, and preventing relapse. Levels of care and settings vary depending on your needs, such as outpatient, residential, and inpatient programs.^[25]

Recovery options include outpatient counseling, which helps people understand addiction, their triggers, and their reasons for using drugs. This form of treatment involves regular sessions with a therapist or counselor.^[26]

Withdrawal therapy

The goal of detoxification, also called “detox” or withdrawal therapy, is to enable you to stop taking the addicting drug as quickly and safely as possible. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis. Others may need admission to a hospital or a residential treatment center.^[27]

Recovery is possible

No matter where you are on the spectrum of substance use disorder, know that this condition is treatable and help is available when you’re ready.^[28] The good news is that substance use disorders are treatable. Like other chronic conditions, they can be managed effectively. Thanks to ongoing research, there are evidence-based methods to help people with substance use disorders improve their health and lives.^[29]

While many people use other terms, the process of managing a substance use disorder is often known as being “in recovery” or “in remission.” There is strength in getting help. With effective treatment, recovery is possible for everyone.^[30]